Thursday, 12 July 2012


I am still fantasizing about buttercream. Evidently there is a buttercream deficiency in my diet.

The G1 exam prep book was written by illiterates. Here's a fun question: "All vehicles must stop and yield right-of-way to pedestrians crossing at marked crosswalk, you should", followed by 4 multiple choice questions. Uh...Okaaaaay. It's also full of helpful tips, like this one: "To get your vehicle out of skid you should steer in the direction of the skid, look where you want your vehicle to go and steer towards that spot."

This explains a lot about Ontario drivers. And I'm going to be one of them!

Harry and Marmalade are as cute as ever, as you can see from the photo below.

My laptop is acting up again. I'm in the market for a desktop.

I will be in Ottawa most of next week.

I meant to plant a garden on my balcony. I still haven't started. Is it too late?

Thursday, 8 December 2011


Today, after many months of looking, negotiation, heartache and headache, my sister and her family are going to close on their new house.

My niece is very excited to have her own room. In fact, she's invented a game called "this is my room," using curtains or chairs or whatever is available to make her own space. Only the select few are invited into her realm. It's very important to close the door/curtain/sofa cushion behind you.

I've become accustomed to my own space. Have not had a roommate since college. My residency call rooms were palaces compared to some; we had our own room and shared a bathroom with the adjacent room. Not that we had much time to sleep, but at least we could close the door and be alone if desired.

Makes sense, then, that the purchase of one's own property is called a "closing." One buys the opportunity to shut others out. One can change the locks and decide who gets a key.

Obviously, the term comes from the thought of finalizing, or "closing" the deal. It's natural to be excited for the finish. We celebrate endings, especially when they mark another beginning.

Perhaps this is why it's so important to have closure in other things: failed relationships; illness and death; everyday arguments. We need to close so that we can start again. With the start comes uncertainty. Will we be better this time? Will we succeed in our next goal? Is this the right house? Is this the right person to marry? Should I have given another chance? Will I be able to live without?

Some things are easier to close than are others. For instance, I have been trying to find closure in my last romance for about eight months now. I wonder if I can't close because I am, impractically, holding out hope that there is a chance for success. All rational evidence points to "no." This particular man has failed to follow through on anything he's promised. Yet, the moment I give myself permission to lose hope - to shut the door - he pops up again. I know my friends are frustrated with me; I frustrate myself! I want to be able to end this and thus allow myself to start something better, healthier. At the same time I am afraid to do it.

Then I think about my sister's house. It was not easy. She was in contract for another house and lost it after a series of random events. Now she has found a better one. I hope that same luck finds me.


The New Brunswick Marathon

On Sunday, November 5, 2006, more than 37,000 runners participated in the ING New York City Marathon.

And then there were the scores of other athletes who did not "run." They are the elite and non-elite wheelchair and handcycle participants. Each year these athletes start the race about an hour before the official start and pass over the NY Marathon course at speeds of up to 26 mph on flat ground.

Richard Rosenthal, a friend and member of the New York Cycle Club, organizes a group of cyclists to clear the way for these marathoners.

This year I was lucky enough to be one of those cyclists. What an inspiration to work with this extraordinary group of "disabled" marathoners!

The New York Times wrote a bit about us here.

Congratulations to all of the runners, riders and helpers who make this day so incredible. There are more of my photographs here. In this photo: many of the women volunteers.

Stress? Fracture.

The New York City Marathon took place on Sunday, November 5, 2006. More than 35,000 runners from all corners of the Earth participated. Thousands of spectators cheered them on. Even Lance Armstrong ran the race this year.

What this means for me as a cyclist is that, after having retired my running shoes after last year's race, I joined some of my cycling mates to marshal the race for wheelchair and handicapped athletes. Marathon Day is possibly the best day of the year in New York City. The positive energy is overwhelming

What this means for me as an orthopedist is that many runners in the marathon come to the office for myraid aches, sprains, pains, twists, cracks and clicks. Most of these issues are benign; they can be treated with rest, cross-training and over the counter medicines.

Some of them are not.

Our bones are made to withstand the forces of our activity. They are remarkable in this quality. They do this through their material properties of strength and elasticity. That is, they either resist the forces or bend to accommodate them. Until they don't.

Fractures occur when the force on a structure exceeds its material properties. Sometimes this happens because the force is too great; a car accident or a fall from a height. In other cases, the material properties of the bone are changed; there is a metabolic disease or age-related change to the bones so that they aren't able to stand up to everyday stresses. Something so simple as stepping from a curb might cause a break.

Finally, there are "overuse injuries." The stresses themselves aren't enough to overwhelm the properties of the bone. But, cumulatively, relentless sub-threshold stresses can cause failure of the bone structure. When we place great, but not failure-level forces across our bones repeatedly, a "stress fracture" can occur.

A person with a stress fracture may have normal xrays. She may only have pain when she does high-impact activity. She may have enough pain to cause her to go to see a doctor. Sometimes the fracture is never detected and the person self-limits because of pain, the fracture heals and life goes on. If symptoms cause concern, an MRI test or a bone scan can detect the injury and treatment can be rendered. However, if the offending activites continue, the bone could snap and require surgery or some other "drastic" measure.

Now our bones are governed by our physiology. Unless there is something wrong with our healing process, bones will mend when treated appropriately.

But what happens when we overwhelm other systems? How do we deal with the relentless sub-threshold stresses on our emotional skeleton? There's nothing so definitive as an MRI test to tell us when we've reached the limits of our patience. The pains related to stress fractures of this nature are vague and difficult to localize.

I've treated four patients in the past 6 weeks with real stress fractures of their bones. One woman had fractures in both hips. Another, in her foot. A young boy had a break in his tibia. Another young lady was unlucky enough to have had a stress fracture which cracked completely and required surgery. All of these folks were under 33 years old.

In contrast, I cannot count the number of patients, mostly young women with small children, who come in for treatment of low back pain, neck pain, hand pain, knee pain, shoulder pain... the list goes on. These women seldom have a concrete medical problem. I believe the issues here are with the taxing of other systems. Many of my such patients sleep only three or four hours per night because of work, house and child care duties. Some have not had a day to themselves for years. They are exhausted, stressed and overwhelmed and this shows up in the form of physical pains.

But how do I treat this? My tool kit includes medicines, therapy and surgery. Is there a way to fortify people so that they are more resilient? Or do we just wait for them to break?

AAOS in San Diego

Floyd Landis, Tour de France winner 2006.

About 30,000 Orthopedic Surgeons from around the world descended on San Diego last week for the American Association of Orthopedic Surgeons annual meeting. San Diego proved to be a superb venue for this meeting. The weather was glorious. The waterside convention center and its surroundings are lovely and boast affordable parking. Attendees need not be limited to the food offerings inside the center, either. There are plenty of great restaurants within blocks of the meeting.

There are terrific academic lectures, instructional courses and symposia (which are my favorites). Physicians from across the globe present their research and discuss new ideas in our field. It's an enlightening, if not overwhelming week.221938-684462-thumbnail.jpg

What most impressed me, however, is my meeting Floyd Landis, winner of the 2006 Tour de France. Mr. Landis underwent right hip resurfacing in September, 2006. He had osteonecrosis of the hip after a serious crash injury years ago. Floyd underwent two operations before the resurfacing procedure. He told me that after his initial recuperation and rehabilitation, he is impressed at his level of function. He's back in full training and will take part (not ride) in the Tour of California this Winter. He's written a book about his innocence in the TdF and will promote it and his defense case during the tour.

And, talk about coincidence! My good friend, Doug, also met Floyd during a recent visit to NYC. Floyd was kind enough to autograph a copy of High Impact Quotations, edited by none other than Richard "Dick" Pound.

Aside from the meeting, I was able to enjoy the fabulous San Diego weather. I rented a Cervelo road bike from the nice folks at Nytro in Encinitias, CA. Each day before the conference, I had a few hours to ride on a stretch of Route 101. It's a gorgeous road with breathtaking ocean views.